1 Boring Old Man

A Ghostwriter Speaks
Neuroskeptic
15 August 2011

PLoS ONE offers the confessions of a former medical ghostwriter: Being the Ghost in the Machine. The article [which is open access and short, so well worth a read] explains how Linda Logdberg became a medical writer; what excited her about the job; what she actually did; and what made her eventually give it up…

However, it doesn’t create bad science. A bad paper is bad because of what it says, not because of who (ghost)wrote it. Real scientists can write bad papers without a ghostwriter’s help. When pharmaceutical companies pay a ghostwriter, they are not doing this to get access to special dark arts that real scientists are innocent of. As far as I can see, it’s just more efficient to use a specialist writer to do your scientific sins, when you’re doing it all the time…

Logdberg says:

^{My career came to an end over a job involving revising a manuscript supporting the use of a drug for attention deficit-hyperactivity disorder (ADHD), with a duration of action that fell between that of shorter- and longer-acting formulations.}
^{However, I have two children with ADHD, and I failed to see the benefit of a drug that would wear off right at suppertime, rather than a few hours before or a few hours after. Suppertime is a time in ADHD households when tempers and homework arguments are often at their worst.}
^{…Attempts to discuss my misgivings with the [medical] contact met with the curt admonition to ‘‘just write it.’’ But perhaps because this particular disorder was so close to home, I was unwilling to turn this ugly duckling of a ‘‘me-too’’ drug into a marketable swan.}

Many scientists will recall being in that kind of situation, albeit in a different context… Turning ugly ducklings into fundable, or publishable, swans, is part and parcel of modern science. Of course, the ducklings are not always as ugly as in the case Logdberg describes, but they are rarely as beautiful as they eventually end up.

Being the Ghost in the Machine: A Medical Ghostwriter’s Personal View
PLoS Medicine
by Linda Logdberg
August 9, 2011

Introduction

Ethical concerns about medical ghostwriting have been directed primarily at “guest” authors and the pharmaceutical companies that pay them. One voice that is largely missing is that of the ghostwriters themselves who, after all, create the documents that are in the ethical and legal crosshairs. Without them, one could argue, there can be no fraud, because it is they who create the fraudulent product. For almost 11 years, I worked as a medical writer, creating a variety of pieces including the occasional ghostwritten article. For the most part, I never saw the finished paper, nor did I care to. This article describes what I did, why I did it, why I stopped doing it, and what I think might be done about the problem of fraud in authorship.

What I Did

… Ghostwriting was a small, but real, part of my duties. I have seen published pieces that are virtually identical to the final drafts I submitted. Regardless of what I wrote, though, for many years I considered my role to be similar to that of a highly paid technician and did not question its ethics.

Why I Did It

…I believe that many of the factors that kept me in medical writing apply to most medical writers. First, I believed that I was helping people: sick people need drugs, and physicians need to know about those drugs to prescribe them appropriately. Second, I had young children and valued the flexibility of working at home, which most meded companies offered at least part of the time. Third, the work was interesting: I interacted with top researchers and was assured of an ease of access that I never would have had as an assistant professor. Fourth, the money was good. Really good, especially compared with the typical assistant professor salary. And perhaps most important in the longer run — it was fun. Traveling, eating in high-end restaurants, wearing fashionable clothes, and rushing to meet important deadlines—what’s not to like?

Why I Stopped Doing It

It turned out, there was quite a bit not to like. I’d started in smaller companies headed by PhDs or MD/PhDs who dealt directly with the primary researchers and the pharmaceutical companies. There were no advertising types in sight, and I had frequent, direct communication with the physician-authors. I saw my role as helping a busy researcher write up research results: he or she did the research, and I got to analyze and describe it. But as my career developed, several of these smaller firms went out of business, and I began to get more work from larger meded companies that were part of large advertising agencies. The bigger the agency, the more likely it was that my contact person was someone without a science background. In the worst of these settings, I discussed projects only with the program manager and had limited—or no—access to the “author.”

The work itself began to lose its charm… In addition, the ethical issues began to tap me on the shoulder: perhaps the most memorable example of this was a contraceptive product that caused severe, unpredictable vaginal bleeding in some women. My job was to draft a monograph that would profile the product’s benefits, one of which, according to the client, was that although the bleeding could be severe, it was at least something that women could anticipate. In other words—the bad news is that a meteorite will strike you, but the good news is—a meteorite will strike you!

This kind of doublespeak became more and more troubling, and my career came to an end over a job involving revising a manuscript supporting the use of a drug for attention deficit-hyperactivity disorder (ADHD), with a duration of action that fell between that of shorter- and longer-acting formulations. However, I have two children with ADHD, and I failed to see the benefit of a drug that would wear off right at suppertime, rather than a few hours before or a few hours after. Suppertime is a time in ADHD households when tempers and homework arguments are often at their worst. So I questioned the account executive at the large agency that had hired me. In particular, I wanted to ask the physician author their view of the drug’s benefits. Attempts to discuss my misgivings with the meded contact met with the curt admonition to “just write it.” But perhaps because this particular disorder was so close to home, I was unwilling to turn this ugly duckling of a “me-too” drug into a marketable swan.

I decided it was time to burn my medical writing bridges and contacted The New York Times, which coincidentally had planned an investigative article on pharmaceutical marketing to physicians. I was interviewed for this article, written by Melody Petersen, by Ms. Petersen and Walt Bogdanich. Shortly after its publication, I received a polite letter from an executive of the meded company asking for all the materials back and reminding me of my confidentiality agreement. I also received a direct threat of legal retaliation in a phone call from my former contact at that agency.

What I Think Now

…

I would hold that scientists who are proud of their work wouldn’t use a ghost-writer in the first place. Writing the article is part of the process. Neuroskeptic points out that the real author can be as big a sinner as any ghost-writer. That may be true, but at least it’s on their hands. That seems dreadfully important to me. And she wasn’t even in contact with the "authors." She was working with a meded handler in an advertising firm.